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Brachial Plexus / Erb’s Palsy

The brachial plexus is an arrangement of nerve fibers running from the spine, and specifically, the lower four cervical (C5, C6, C7 and C8) nerve roots and first thoracic nerve roots (T1). These nerves proceed through the neck, down into the axilla (armpit region) and into the arm. The brachial plexus is divided into Roots, Trunks, Divisions, Cords and Branches. There are five roots (C5-8 & T1). These five roots merge to form three trunks (superior/upper: C5-6; middle: C7; and inferior/lower: C8-T1). Each trunk then splits into two, to form six divisions (the anterior division of the upper, middle and lower trunks; and posterior divisions of the upper, middle and lower trunks).

Injuries to one or more of the nerve roots comprising the brachial plexus often occur as the result of excessive traction (force) being placed on the head/neck of a newborn by the obstetrician during the delivery after the newborn’s shoulder has become stuck / impacted behind the mother’s pubic bone. This phenomenon is more commonly referred to as shoulder dystocia. As the result of the negligent application of excessive force to the newborn’s head / neck, the newborn can suffer stretching or tearing (“avulsion”) type injuries one or more of the nerve roots comprising the brachial plexus region. The term avulsion refers to the forcible tearing away or separation of the nerve root from the spine; i.e., the mechanism of injury is such that it involved enough stretching force to detach the nerve roots from the spine.

Nerve root injuries to the brachial plexus can only be diagnosed utilizing a CT myelogram. The signs of a nerve root injury to the brachial plexus include loss of sensation in the arm, paralysis, sensory changes, atrophy of the muscles and the noticeable positioning of the arm hanging down by the baby’s side. Typically, the baby’s arm cannot be raised from the side and the elbow is not flexible. More often than not, the growth of the arm will be stunted as well due to impaired musculature and circulatory development. If the injuries to the nerves are limited to “stretching” type damage, the injuries may be temporary in nature and resolved with dedicated physical therapy. If however, the newborn suffers an avulsion (tearing) type injury to one or more of nerves comprising the brachial plexus, it is likely that the injuries will be permanent, rendering it likely that he / she will never be able to use the hand / arm functionally during their lifetime. Paralysis of the arm caused by injury to the arm’s main nerves (usually C5-6) is known as Erb’s palsy. Again, the most common cause of Erb’s palsy is shoulder dystocia during birth. Although some neurosurgeons will attempt to repair the nerve root avulsion by grafting a nerve from another location of the body into place on the torn-apart nerve, these procedures are often unsuccessful.

It is recommended that newborns afflicted with Erb’s palsy receive weekly physical and occupational therapy to help develop muscle strength. In addition, as these newborns grow older, often times they are forced to endure painful surgeries at the shoulder, elbow, wrist and finger in an effort to improve function in those areas. Still other children receive regular Botox injections to help improve shoulder and wrist function. Notwithstanding these therapies, victims of shoulder dystocia / permanent Erb’s palsy more often than not require a variety of accommodations, services and supports throughout their lifetime, the cost of which can be extremely high. Often times, the cost for this lifetime of care can be financially ruinous for a family. For these reasons, we strongly recommend that you consult with our Medical Malpractice / Wrongful Death team to see if your child’s injuries were caused by a medical mistake for which you are entitled to a lifetime of compensation and care. Our lawyers routinely work with specialists such as doctors, life care planners, vocational rehabilitation counselors and economists to ensure that our clients are fairly and adequately compensated for all of the injuries that they have experienced and will experience into the future.

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